Infliximab (REMICADE and biosimilars)
Induction Infusion dose based on clinical decision making:
Given at week 0, 2, 6.
Obtain level prior to 3rd dose given at 6wks
Maintenance
If Dose 3 level >18 and clinically improved, schedule for q8wk infusions
If Dose 3 level <18, schedule for q4wk infusions and check a repeat level
Goal Level based on phenotype
IBD without complication >8
IBD with Fistula or strictures >10
VEO-IBD or IO-IBD >15-20
Vedolizumab (Entyvio)
Induction based on weight; given at weeks 0, 2, 6.
>50kg: IV: 300mg
<50kg: IV: 5-6mg/kg
Obtain level prior to 3rd dose at 6wks
Maintenance (same dosing as induction)
If 3rd dose level >24, schedule infusions at q8wks
If 3rd dose level <24, schedule infusion at q4wks and repeat levels
Goal Level >15
Stelara (Ustekinumab)
Induction infusion dose based on weight
<55 kg: IV: 260 mg as single dose.
≥55 to 85 kg: IV: 390 mg as single dose.
>85 kg: IV: 520 mg as single dose.
Maintenance
SUBQ: 90 mg. Obtain Level prior to first maintenance dose
If level >5, schedule injections at q8wks
If level <5, schedule injections at q4wks and obtain repeat level after 3rd injection
Goal level >4.5
Adalimumab (Humira and biosimilars)
Induction based on weight
>40kg: SubQ: 160mg followed by 80mg at 14 days
<40kg: SubQ: 80mg followed by 40mg at 14 days
Maintenance
>40kg: SubQ: 40mg q2wks
<40kg: SubQ: 20mg q2wks
Goal Level >12